Healthcare Provider Details

I. General information

NPI: 1497242192
Provider Name (Legal Business Name): BRIAN G. HACKLEMAN, D.C., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 S SPRINGFIELD AVE
BOLIVAR MO
65613-2040
US

IV. Provider business mailing address

341 S SPRINGFIELD AVE
BOLIVAR MO
65613-2040
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-3527
  • Fax: 417-326-3529
Mailing address:
  • Phone: 417-326-3527
  • Fax: 417-326-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN GEORGE HACKLEMAN
Title or Position: OWNER
Credential: DOCTOR OF CHIROPRACT
Phone: 417-326-3527